Luiza Kalil, MD

Tips for Treating Hair Loss, With Luiza Kalil, MD

spoke with Luiza Kalil, MD, assistant professor at Yale School of Medicine at the 2025 New Wave 

 meeting in Aventura, Florida, on May 16, 2025, regarding her session, “The Experts Guide to Hair Loss.”

In her presentation, she discussed how to systematically evaluate patients with hair loss using clinical examination and tracheoscopy, when to use laboratory tests to differentiate various types of hair loss, and how to distinguish between scarring and non-scarring alopecia.

“[A] hair loss appointment [is] sometimes different from the general dermatology appointment,” Kalil told 

. “We use [hair loss appointments] because it takes longer…you have to be really meticulous when you're talking to your patient regarding the clinical history and their hair evaluation. It’s really helpful if you have the medical history, a family history, and then you do the trichoscopy and… making sure you're diagnosing scarring or non-scarring.”

Hair loss can be scarring (lichen planopilaris, frontal fibrosing alopecia) or non-scarring (telogen effluvium, androgenetic alopecia, and alopecia areata). Kalil explained that there is no standardization when it comes to using laboratory tests to differentiate different types of hair loss.

“I usually do [lab tests] when I need to check if the patient has any nutritional deficiencies,” Kalil said.

In laboratory tests, dermatologists could look for CBC, CMP, TSH, iron and ferritin, 25-hydroxyvitamin D, Zinc and B12, ANA, hemoglobin A1C, immunoglobulin E, and TB screening plus hepatitis/HIV if considering a JAK inhibitor. If there are hyperandrogenism signs, patients could get lab tests for SDHEA and testosterone.

Dermatologists should evaluate hair loss by asking patients about their hair loss duration and rate of progression, symptoms, hair care practices, medical history, and family history. They should also assess the location, pattern, and extent of hair loss.

Some of Kalil’s patients hope vitamin supplements will help with hair loss, though the cause may be unrelated. Still, checking for vitamin deficiency can be a helpful step.

Hair loss can progress from catagen, telogen, and exgoen. A shift from catagen to telogen could be caused by a fever, drugs, surgery, stress, nutritional deficiencies, diet and weight loss, thyroid deregulations, systemic lupus, COVID-19, and scalp diseases.

The telogen category, defined by shedding, reduction in scalp hair density, and no scale, inflammation, pustules, or scarring, can be identified by the hair pull test with > 5 hairs in a single pull or > 15 in 3 pulls. Helpful vitamins may be vitamin D, zinc, biotin, and vitamin B12; they may also have too much vitamin A and selenium.

Kalil said that a patient might need a biopsy—1 vertical and 1 with transverse sections— if she wants to confirm the diagnosis or look for scarring. Biopsies should take place at the peripheral margin of the alopecia area, which is active and with hair.

Dermatologists can identify non-scarring hair loss by specific tracheoscopy features. For instance, alopecia areata features constrictions of broken hairs, black dots and exclamation marks, and yellow dots. AgA features hair diameter diversity and miniaturized hair. Telogen effluvium features short regrowing hairs.

The absence of follicular ostia indicates scarring. Lichen planopilaris features perifollicular scaling, perifollicular erythema, and blue-gray dots. Frontal fibrosing alopecia features perifollicular scaling, perifollicular erythema, and loss of vellus hairs.

, and it's really exciting because [there is] a lot of new data for scarring alopecia and also [for] scarring alopecia,” Kalil said, “It’s really good [for hair loss treatment] because there are so much going on, but we really need to make sure we are doing the best for our patients. So read about safety data and read about efficacy before [starting] to do anything.”

Kalil L. The Experts Guide to Hair Loss. Presented at 2025 New Wave Dermatology in Aventura, Florida on May 15, 2025.

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At New Wave Derm 2025, Kalil shared expert tips on evaluating and diagnosing scarring vs non-scarring hair loss using clinical tools.

Incorporating New Hair Loss Treatments in Your Clinic, with Luiza Kali, MD

 meeting in Aventura, Florida, on May 16, 2025, Luiza Kali, MD, assistant professor at Yale School of Medicine, presented “Innovative Treatments for Hair Loss.” As a part of HCPLive’s on-site coverage, we spoke with Kalil about therapies she prioritizes for hair loss and the evolving hair loss treatment landscape.

“It's really exciting to be here today because, for a long time, people just thought about hair loss disorder as a cosmetic thing, and we know for patients [it’s] much more than that,” Kalil said. “It's emotional—they get anxiety, they get depression. It’s really good to have more things now and more treatments for that, but there are a lot of new research coming, so we have to understand the new research to try to use the new treatments in our daily lives and to know their efficacy and their safety to make sure we’re doing the best for our patients.”

During her session, Kalil discussed emerging treatments for frontal fibrosing alopecia and androgenetic alopecia.

Mild alopecia areata treatments include topical corticosteroids, IL-TAC, topical/oral minoxidil, and immunotherapy. Moderate cases are treated with topical/systemic corticosteroids, oral minoxidil, JAK inhibitors, immunosuppressants, and immunotherapy. Severe cases are treated with JAK inhibitors, oral minoxidil, dupilumab, or immunosuppressants.

Baricitinib (2022): 2–4 mg/day for ≥18 years

Ritlecitinib (2023): 50 mg/day for ≥12 years

Deuruxolitinib (2024): 8 mg twice daily for ≥18 years (not yet available)

Ritlecitinib (ages 6–12, phase 1 completed)

Deuruxolitinib (≥12 years, phase 3 underway)

Although no head-to-head JAK inhibitor comparisons exist, a 2024 systematic review found ritlecitinib 50 mg and baricitinib 4 mg similarly effective.

Emerging treatments for alopecia areata include dupilumab and biologics. A placebo-controlled trial evaluated dupilumab (300 mg weekly) in 60 adults with SALT ≥30.

 Bempikibart, which rebalances T effector and T regulatory cells, achieved SALT ≤20 in 21% of patients at week 26.

First-line treatments for frontal fibrosing alopecia include steroids, 5-α reductase inhibitors, hydroxychloroquine, and doxycycline. Second-line therapies include minoxidil and immunosuppressants.

Emerging treatments include topical (tofacitinib 2% cream QD, Ruxolitinib cream 1.5% BID or QD, Delgocitinib cream 2% BID) and oral (tofacitinib 5mg twice daily, Baricitinib 4mg daily, Upadacitinib 15mg daily, Brepocitinib) Jak inhibitors. Phase 2 trials are complete.

Another condition touched upon was androgenetic alopecia. First-line treatments include minoxidil and antiandrogen (5-alpha-reductase inhibitors, including finasteride/dutasteride), spironolactone, and bicalutamide. Second-line treatments include mesotherapy, micro needling, platelet-rich plasma, and lasers and low-level light therapy.

Microneedling targets affected areas with minimal systemic adverse events, but it’s painful, less effective than oral options, and lacks standardization. Platelet-rich plasma improves density and thickness with chemical activation but requires ≥3 sessions and stronger scientific backing.

Photobiomodulation is non-invasive and safe but costly, limited as monotherapy, and the benefits may fade post-discontinuation. Ablative lasers may damage follicles.

Emerging treatments for androgenetic alopecia include Botulinum toxin, new antiandrogens, prostaglandin analogs, and drugs targeting the prostaglandin pathway, stem cell therapy, and micelle inhibitory RNA.

“For now, I would keep with the first line treatments, the ones that we have already used for a long time,” Kalil said. “We have been using minoxidil for a long time with good results. We just started using the oral form of it, which is really good, and I really like it for non-scarring and for scarring alopecia. There are new anti-androgen therapies that are really good, but I will keep [with] a first line for now, until we have more data for the new, innovative treatments.”

Aceituno D, Fawsitt CG, Power GM, Law E, Vaghela S, Thom H. Systematic review and indirect treatment comparisons of ritlecitinib against baricitinib in alopecia areata. 

. Published online October 24, 2024. doi:10.1111/jdv.20372

Guttman-Yassky E, Renert-Yuval Y, Bares J, et al. Phase 2a randomized clinical trial of dupilumab (anti-IL-4Rα) for alopecia areata patients. 

. 2022;77(3):897-906. doi:10.1111/all.15071

King B, et al. Initial Results From The SIGNAL-AA Study: Randomized Placebo Controlled Phase 2a Trial of a Bempikibart. Late-breaking data presented at the 2025 AAD Meeting. March 8, 2025

Dunn C, Griffith V, Coican A, et al. Janus kinase inhibition for the treatment of refractory frontal fibrosing alopecia: A case series and review of the literature. 

. 2023;40:47-52. Published 2023 Aug 11. doi:10.1016/j.jdcr.2023.07.037

Williams KN, Perez SM, Burroway B, Tosti A. Topical ruxolitinib in the management of frontal fibrosing alopecia and/or lichen planopilaris: A single-center retrospective cohort study. 

. 2025;92(1):170-172. doi:10.1016/j.jaad.2024.09.032

Chen LC, Ogbutor C, Kelley KJ, Senna MM. Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia. 

. 2024;90(6):1260-1262. doi:10.1016/j.jaad.2024.01.060

Nohria A, Desai D, Shapiro J, Bordone L, Lo Sicco K. Review of the use of Janus kinase inhibitors in the treatment of scarring alopecia. 

. 2024;63(6):e105-e110. doi:10.1111/ijd.17153

English RS Jr, Ruiz S. Skin Appendage Disord. 2022 Mar;8(2):93-100.

Müller Ramos P, et al. An Bras Dermatol. 2023 Jul-Aug;98(4):506-519

DuBois J, et al. Clin Cosmet Investig Dermatol. 2021 Oct 15;14:1507-1517.

Piraccini BM, et al.. J Eur Acad Dermatol Venereol. 2022 Feb;36(2):286-294. Erratum in: J Eur Acad Dermatol Venereol. 2023 Feb;37(2):452.

Kalil discusses the latest advancements in hair loss treatments, including innovative therapies and ongoing research in dermatology for effective solutions.

Luiza Kalil, MD

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